Vitamin D - Update
Royal College of Paediatrics & Child Health London December 9, 2010
Professor Robert Heaney Mike Fischer Rufus Greenbaum
A meeting was held on December 9, 2010 on the occasion of the visit to London of Professor Robert Heaney. It was held at the headquarters of the Royal College of Paediatrics & Child Health, although they did not endorse the meeting. It was sponsored by Systems Biology Laboratories ( www.sbl-uk.org ) through the generosity of the Fischer Family Trust and their Director, Mike Fischer. Invitations were sent to: • Doctors and Pharmacists who had written to the BMJ about Vitamin D • The Mailing List of the Vitamin D Council ( www.vitamindcouncil.org ) • Members of DEQAS ( www.deqas.org ) • Personal contacts of Rufus Greenbaum ( www.rufusgreenbaum.com ) Over 50 people from UK, Europe & USA attended. These documents are available on request from Rufus Greenbaum: ( Email: [email protected] ) • 2-page Overview & Summary • 28-page Report of comments and inputs from people at the meeting • List of attendees with copies of Business cards or contact information • Presentation – Introduction to Vitamin D in the UK ( By Rufus Greenbaum ) • Presentation & Notes – Introduction to Vitamin D in the UK ( By Rufus Greenbaum ) • Presentation – State of the Evidence ( By Professor Robert Heaney )
1 Vitamin D - Update
2:00 Introduction & Overview RG 2:15 Overview of the evidence RH 3:00 IOM Report – Commentary RH 3:15 Discussion on the IOM Report All 3:30 Roundtable Discussion All - How some doctors treat Vitamin D deficiency - How to treat Vitamin D deficiency - Next Steps 5:00 End
The meeting was held 10 days after the USA Institute of Medicine ( IOM ) issued a report on Dietary Reference Intakes for Calcium and Vitamin D.
Professor Robert Heaney gave an overview of the evidence linking lack of Vitamin D and many illnesses.
He then gave his comments about the IoM report
Following this, about 20 of the audience gave comments and examples of their experience in diagnosing, testing and treating illnesses due to lack of Vitamin D
A more detailed report of the discussions and a copy of the presentation by Professor Robert Heaney are available on request from: [email protected]
2 Theoretical Mortality Curve
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In a previous presentation, Professor Robert Heaney has suggested that the majority of healthy babies are born with the potential to live to 70-80 years. Quite by chance in March 2008 I read an article in “Wired” magazine about Ray Kurzweil and the actions that he was taking to live longer. Around 40 years old he had developed initial signs of Diabetes. He did not like the medication and the side effects, so he researched possible alternative treatments. Ray Kurzweil wrote about his findings in his first book: “The 10% Solution for a Healthy Life”, which I read in April 2008. His suggestions included: • Eat less Calories, subject to optimum nutrition • Eat less fat ( typically <10% ) • Take modest exercise ( brisk walking for 30-60 minutes each day ) I had previously developed high blood pressure at about age 40, had a “fatty liver” and had done no exercise. I put his suggestions into practice, reduced my weight from 83kg to 65kg between April-December 2008, improved my blood results, reduced my blood pressure and had much more energy. When I started this regime I bought a copy of the book for my doctor, who threw it onto a side table, saying “I may read this one day” At a check-up after 2 months he said: “I don’t know what you are doing, but keep doing it. I had better read the book” – which he did.
3 Live Longer
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Professor Robert Heaney had suggested that poor nutrition and lack of adequate exercise meant that the dotted line showed the typical life expectancy for the average population.
I was on that dotted line when I retired in 2006, after working for 40 years in the Electronics industry.
4 Live Longer – my sources
Books: 10% solution Ray Kurzweil Fantastic Voyage Ray Kurzweil & Dr Terry Grossman TRANSCEND Ray Kurzweil & Dr Terry Grossman The CR Way Paul McGlothin & Meredith Averill Ending Aging Aubrey de Grey & Michael Rae Maximum Life Span Roy Walford +++ Websites: www.fantastic-voyage.net www.rayandterry.com www.crsociety.org www.sens.org
I researched how to “Live Longer” and read the books Fantastic Voyage and TRANSCEND which are about “preventative health”. They report that certain chemicals in our bodies are at their maximum at about age 25 and reduce significantly as we grow older. For example, for people with Alzheimer’s & Osteoporosis, some of these chemicals may drop to as low as 5% of their peak and, using new techniques such as MRI scans, the signs can be seen 25 years before the onset.
Among many other topics they include recommendations about taking a small group of supplements.
This includes taking enough Vitamin D to get 25(OH)D up to 125 nmol/L ( 50 ng/mL )
One of the chapters in Fantastic Voyage is about heart disease, how to prevent it and what to do after being diagnosed with heart problems to avoid it happening again – which I think of as a guide to “life after Stents”. I lent this book to a friend who had just had an Angioplasty and had had Stents fitted. He returned the book after a month, but he had not read it. He is a wealthy man who seems to prefer to pay for expensive doctors to repair his faulty body, rather than taking personal action to avoid the problem happening in the first place or to help his recovery.
5 The role of Vitamin D ?
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Today we are going to look at the role that Vitamin D plays in helping the human body to work better for longer.
I bought the 2 books “Fantastic Voyage” and TRANSCEND for my 2 sons - for them, their wives and children - who have improved their health and lifestyle by changing the food that they eat and doing a little exercise.
I also bought both books for my doctor, who told me at that time that: “supplements are a waste of money - they are just flushed down the toilet”.
I had my Vitamin D levels tested: Mid 2009 20 ng/mL 50 nmol/L ( so I took 1,000 IU of Vitamin D3 per day ) Oct 2009 30 ng/mL 75 nmol/L ( so I took 5,000 IU of Vitamin D3 per day ) Jan 2010 67 ngl/mL 167 nmol/L
6 Vitamin D – my sources
Books: Vitamin D & cholesterol Dr David Grimes The Vitamin D Solution Dr Michael Holick The Vitamin D Cure Dr James Dowd Power of Vitamin D Dr Sarfraz Zaidi 4 online books Dr Oliver Gillie Websites: www.vitamindwiki.com Evidence & commentary www.grassrootshealth.net Call To Action & Videos www.vitamindcouncil.org Evidence & commentary www.healthresearchforum.org.uk 4 online books [email protected] 7
I read more about Vitamin D and began to ask experts for their opinions. I met with Dr David Grimes, who is a Consultant Gastroenterologist at Blackburn Hospital in the UK, and he kindly gave me a copy of his book. In this book he reviews and explains an extensive number of scientific papers about the deficiency of Vitamin D, particularly by inadequate exposure to the sun. He suggests that this suppresses immunity and makes people more susceptible to a number of diseases including heart attacks, strokes, several cancers, diabetes and multiple sclerosis. The books by Professor Michael Holick, Dr James Dowd and Dr Sarfraz Zaidi offer very practical advice about ways to diagnose, measure and treat many illnesses that might be due to lack of sunlight and the resulting low Vitamin D. At www.grassrootshealth.net I was introduced to video recordings of a group of eminent scientists speaking at a number of scientific conferences and I spent many hours watching these talks. ( www.ucsd.tv – search for “Vitamin D” ) In mid 2009 I met with Dr Elina Hypponen and Dr Oliver Gillie, who suggested that I look at the sources of medical and scientific advice in the UK. They recommended that I look at the Scientific Advisory Committee on Nutrition ( www.sacn.gov.uk ) and the National Institute for Health & Clinical Excellence ( www.nice.org.uk ) In December 2009 I went to an open meeting of the Food Standards Agency, which then provided the Secretariat of the SACN, and asked a formal question about whether they were aware of the relationship between Vitamin D & Cancer. Their answer was that one could get enough Vitamin D from food and sunshine.
7 Vitamin D – Overview
. . diverse range of health problems associated with vitamin D deficiency. ( with list of over 60 illnesses )
Dr Peter Lewis Manly, Sydney, Australia BMJ Rapid Responses, January 2010
I searched for “Vitamin D” in all the scientific journals.
In the BMJ I found some major review articles about Vitamin D, published in 1998, 2005 and January 2010. These were followed by a series of Rapid Responses in which Doctors, Pharmacists and others discussed: • how lack of sunlight is implicated in many illnesses • problems in measuring 25(OH)D • lack of suitable products in the British National Formulary ( listing of approved medicines that UK Doctors can easily prescribe )
My overall impression was that they were asking the UK Department of Health for “something to be done”.
One of the correspondents in the BMJ was Dr Peter J Lewis who now lives and works in Australia. He kindly sent me the leaflet that he gives his patients, which explains and lists over 60 illnesses that he suggests may be associated with deficiency of Vitamin D. This is available in your handout and on request from me at: [email protected]
8 Disease Prevention
In all the medical literature that I read during 2008-2009 there were many scientific papers that suggested that if I eat this food or did not eat that food I could reduce my risk of a certain illness by maybe 1-5%.
I then found this Disease Incidence Chart at www.grassrootshealth.net that suggested that there was a way to reduce the risk of “All Cancers” by 77%
Was this “Snake Oil” or real scientific evidence ?
What the chart shows is the risk of certain illnesses versus the level of Vitamin D in the blood, compared to a reference level of 62.5 nmol/L ( 25 ng/mL )
The solid bars are based on Level 1 Randomised Controlled Trials and the dashed bars are extrapolations of the risks.
The chart is based on a paper: “Vitamin D for Cancer Prevention: Global Perspective” by Professor Cedric Garland and others in the Department of Family and Preventive Medicine, University of California, San Diego, USA.
I also read a paper: “Vitamin D in preventive medicine – Are we ignoring the evidence ?” by Professor Armin Zittermann, Department of Nutrition Science, University of Bonn, Germany.
9 Vitamin D – Overview 2
Henry Lahore at www.vitamindwiki.com has re-drawn the data in the paper by Professor Cedric Garland.
These data show the preventative benefit of having a higher level of Vitamin D and how this reduces your chance of having certain illnesses.
10 Vitamin D – Overview 3
There is strong proof that increased levels of Vitamin D both reduce the incidence and help recovery for about 10 diseases.
The proof, from randomised controlled trials and epidemiological studies, is not so strong for other diseases. However, there are Case Studies and reports from doctors that suggest that there is a very strong association for an additional 25 diseases.
There are another 25 diseases where there the lack of Vitamin D is suspected to be related, some with very strong anecdotal evidence such as with Autism.
This chart comes from www.vitamindwiki.com where you can read extracts from the scientific papers and commentaries.
You can also search this website for the data and evidence by any search term, such as illness or author.
11 Vitamin D – Call to Action - 1
At www.grassrootshealth.net more than 30 eminent scientists have signed a “Call To Action” regarding Vitamin D.
Note their claim that 40-75% of the world’s population is Vitamin D deficient.
I have discussed this with my doctor and he is now routinely testing more of his patients for Vitamin D. He is frustrated that there is not a suitable product in the British National Formulary that he can easily prescribe. ( BNF is the guide for UK doctors and pharmacists of recommended medicines )
As a result he now advises his patients to go to a local health-food store and buy 1000 IU tablets of Vitamin D3. This goes against his previous advice that “supplements are a waste of money - they are just flushed down the toilet”.
A local pharmacist has recently told me that there is a 20,000 IU capsule of Vitamin D3 that can be obtained, but it is a “special” and not listed in the BNF.
12 Vitamin D – Call to Action - 2
This “Call To Action” recommends that blood serum levels of Vitamin D should be between 100-150 nanomols/Litre ( 40-60 ng/mL ) In late December 2009, a week after I had written to the SACN, my wife went for a routine mammogram and was diagnosed with early stage Breast Cancer. In January 2010 she had a Lumpectomy and 3 Lymph nodes were removed. The biopsy showed that only 1 of the 3 Lymph nodes were affected. During February and March 2010 she had Radiotherapy. She did not have Chemotherapy as her Oncologist calculated that this might add only an extra 2% to her chance of recovery. As soon as the Cancer was diagnosed I called some of the experts who had signed the Call To Action and a number of them advised: “Get her 25(OH)D up to 150 nmol/L ( 60 ng/mL ) as fast as possible, as it will help her recovery” A blood test in October 2009 had shown her 25(OH) to be 50 nmol/L ( 20ng/mL ), so I gave her capsules of Vitamin D3 of 5,000IU per day. We discussed this with her Oncologist in February 2010. She did not seem to have much have experience of this and did not normally test for Vitamin D, so she referred my wife to an Endocrinologist. By March 2010 my wife’s Vitamin D level was 117 nmol/L ( 46.8 ng/mL ) and by August 2010 , after a holiday in a sunny country, it was 145 nmol/L ( 58 ng/mL ) and her Calcium was high. The Endocrinologist decided that this was too high and advised her to stop the Vitamin D for 1 month and then to continue with 1,000 IU per day. I argued with the Endocrinologist that he might be reducing her chance of recovery from Cancer, solely in order to manage her high Calcium and a risk of Kidney Stones. Since I am not a doctor, my wife decided that she must follow the advice of the experts treating her and is currently taking 1,000 IU of Vitamin D3 per day.
13 Vitamin D - UK - National
Department of Health Secretary of State for Health Andrew Lansley Minister of State for Health Simon Burns Minister of State for Care Services Paul Burstow Under Secretary of State for Public Health Ann Milton Under Secretary of State for Quality Lord Howe Chief Medical Officer ( CMO ) National Institute for Health & Clinical Excellence ( NICE ) Scientific Advisory Committee on Nutrition ( SACN ) Medicines & Health Regulation Agency ( MHRA ) Food Standards Agency ( FSA ) Other key influencers ? [email protected] 14
In early December 2009 I wrote to the Chairman of the UK government SACN, asking them to review their guidance on Vitamin D & to consider: 1. Recommendations for a reference level of 25 hydroxy-vitamin D 2. Recommendations for Safe Upper Intake Levels of Vitamin D 3. Recommendations for the general adult public about supplementation 4. Recommendations for women who are pregnant or wish to become pregnant 5. Recommendations for supplementation for new-born children 6. Recommendations of the EU CPME policy document: “Vitamin D nutritional policy in Europe” (CPME 2009/179 Final EN) I wrote to all the UK government Ministers for Health & associated scientific advisors with copies of the letter to the SACN. I hand-delivered them to their Personal Assistants, together with a CD-ROM of evidence and the book by Dr David Grimes. I repeated this when all the Ministers changed after the UK election in May 2010. Of course, I received the usual acknowledgements and bland replies. My correspondence with the SACN is visible in the website of www.sacn.gov.uk There is a comment in the minutes from their meeting of February 26, 2010 that the SACN only does “Risk Assessment” and that: “. . many of the issues raised in the letter related to Risk Management considerations, and therefore outside the Committee’s remit.” A CD-ROM of all the correspondence and evidence is available on request from [email protected]
14 Vitamin D - UK - Local
• Local Primary Care Trust * Public Health * Paediatric Endocrinology * Community Paediatrics * Community Dietetics * Health Visitors * Midwives * General Practice * Pharmacy • Collaboration for Leadership in Applied Health Research and Care * Potential NHS project: Vitamin D – Implementing Best Practice I missed £100,000 funding for 18-month trial with Mothers & Babies I made contact with Paediatricians in 20 hospitals in NW London
I wrote to the Chair of my local NHS Primary Care Trust, asking that they consider an Observational Study with a selected group of local General Practitioners. This was to support the GPs in measuring the Vitamin D blood serum levels of patients and to measure both the Health Outcomes and the associated financial costs or savings. This was rejected. In March 2010 I attended an open meeting of this NHS Primary Care Trust and met their Director of Public Health. I was aware that he was opposed to any preventative actions regarding Vitamin D, since he had written about this to the BMJ ( Rapid Responses - January 2010 ), and this was confirmed at the public meeting. At this meeting I met a member of their LINKS who suggested that the NHS National Institute for Health Research ( NIHR ) might be a more suitable place. I was introduced to the NHS Collaboration for Leadership in Applied Health Research and Care ( CLAHRC ) who had previously provided 2 rounds of funding for trials in how to improve health care within the NHS. I wrote a detailed Proposal for CLAHRC funding of £100,000 for a trial entitled: “Vitamin D – Implementing Best Practice”. 66 groups submitted Proposals and mine was 1 of 39 that passed the first selection process in July 2010. However, I could not find a clinical lead for the project and was unable to submit a final Proposal by the deadline of September 30, 2010. 25 Proposals for different projects were submitted by other groups. These will be judged by December 31, 2010 and 5 successful groups will then start an 18-month trial in April 2011. The outcome of searching for a clinical lead was that I made contact with Paediatricians in 20 hospitals in hospitals in NW London.
15 UK Hospitals – St Mary’s Paddington
Dear Rufus, We all recognise this is a very serious problem and last year we had some very sick children presenting here with seizures, Stridor and heart failure due to vit D deficiency. Please make contact with Mike Coren who is our lead for vit D. I am sure he would be interested to collaborate with you. Hermione Lyall MD Consultant Paediatrician, Infectious Diseases Chief of Service for Paediatrics Imperial College Healthcare NHS Trust Sep 17, 2010
Dr Hermione Lyall heads the Paediatric group in St Mary’s Hospital in Paddington, which is also associated with the Westminster NHS Trust .
I met with Dr Mike Coren, who deals with children who are admitted to hospital with many illnesses due to severe deficiency of Vitamin D. Together with colleagues he has helped to write: “Treatment and Prophylaxis Guidelines for Vitamin D Deficiency in Infants, Children and Adolescents”
I met with Eva Hrobonova, who is a Consultant in Public Health in Westminster NHS Trust. She is implementing these Guidelines, by holding meetings with Doctors, Nurses, Midwives and other health professionals in Westminster.
The approach to this is very variable across the United Kingdom.
For example, I am aware that the Birmingham & Bristol Primary Care Trusts have similar programmes, but that many other PCTs do not.
I met with Dr Benjamin Jacobs and Dr Priscilla Julies at the Royal National Orthopaedic Hospital in Stanmore, London, UK. They have similar cases to St Mary’s Hospital and gave me a copy of their Guidelines for testing and treating children for Vitamin D deficiency.
Copies of these and other Guidelines are available in your handout and by email from [email protected]
16 UK Hospitals – Blackburn
Over the past 35 years I have seen immigrants arrive from India, Pakistan & Bangladesh Within 5-10 years many of them have become ill Some of their children have been born with rickets Dr David Grimes Consultant Gastroenterologist Blackburn Hospital PS: I am resolving many gastric problems, such as Irritable Bowel Disease & Crohn’s Disease with large doses of Vitamin D
Since mid 2009 I have had a close dialogue with Dr David Grimes.
He has written about Vitamin D in the BMJ and other journals about the medical implications of the lack of sunlight.
In his book: Vitamin D and Cholesterol – the importance of the sun he suggests that it is the lack of sunlight, and the resultant deficiency of Vitamin D, that makes people particularly susceptible to heart attacks, strokes, diabetes and cancer etc.
17 UK Hospitals – Blackburn
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0 1 47 93 139 185 231 277 323 369 415 461 507 553 599 645 691 737 783 829 875 921 967 1013 1059 Number of Patients [email protected] 18
Dr David Grimes gave me this anonymous data on more than 1,000 patients that had been tested for Vitamin D in Blackburn Hospital.
It should be noted that this graph is not representative of the general population, as a doctor had already suspected that these patients might be deficient in Vitamin D and had sent them for a test.
Note that: about 70% are below 50 nmol/L more than 20% are below 20 nmol/L
18 UK Hospitals – Ealing
17 infants admitted from 2006 to 2008 - hypocalcaemic seizures, secondary to vitamin D deficiency - majority had raised alkaline phosphatase and parathyroid hormone levels - many had delays in achieving gross motor milestones especially in walking, as was reported in Victorian times. Small numbers of cases presented with cardiac failure, clinical rickets, tuberculosis, fractures and respiratory complications including wheezing in infancy. Dr Colin Michie Consultant Paediatrician Ealing Hospital [email protected] 19
I met with Dr Colin Michie, Consultant Paediatrician at Ealing Hospital. He is also a member of The British Paediatric Surveillance Unit, that monitors rare medical conditions of children.
He told me about some Somali women who have arrived at his hospital with new-born babies who are ill and that a few of these women may never have seen a UK doctor.
The Deputy Mayor of Ealing is a Somali woman and they are discussing how to take the health-care messages to the ethnic communities through people like her.
19 UK Hospitals – Ealing
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0 1 254 507 760 1013 1266 1519 1772 2025 2278 2531 2784 3037 3290 3543 3796 4049 4302 4555 4808 5061 Number of Patients [email protected] 20
Here is anonymous data from over 5,000 patients that have been tested for Vitamin D at Ealing Hospital.
It should be noted that this graph is not representative of the general population, as a doctor had already suspected that these patients might be deficient in Vitamin D and had sent them for a test.
Note that: about 70% are below 50 nmol/L more than 20% are below 20 nmol/L
20 UK Hospitals – Wexham Park
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Debbie Greaves, Biomedical Scientist at Wexham Park Hospital, near Slough, UK sent me this data the day before the meeting.
They have recently started testing Vitamin D in-house and this graph shows the results from the first 200 patients.
21 UK Hospital – “Ethnic”
This chart and the next one come from a hospital that must remain anonymous.
They show the test results from 2280 patients that were classified into: 1477 “ethnic” 803 “non-ethnic”
The “ethnic” patients were typically people from South-East Asia, such as Bangladesh, India, Pakistan & Somalia and had very dark skin.
The “non-ethnic” patients were typically people born in England and had lighter skin.
Note the differences in the distribution of their test results.
22 UK Hospital – “Non-ethnic”
This chart and the previous one come from a hospital that must remain anonymous.
They show the test results from 2280 patients that were classified into: 1477 “ethnic” 803 “non-ethnic”
The “ethnic” patients were typically people from South-East Asia, such as Bangladesh, India, Pakistan & Somalia and had very dark skin.
The “non-ethnic” patients were typically people born in England and had lighter skin.
Note the differences in the distribution of their test results.
23 UK Data – England ( 50-55°N )
This chart comes from a paper by Dr Elina Hyppönen and Chris Powers of the Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK. It was published in 2007 and shows results from a white-skinned cohort born in UK in 1958, who were 45 years old at the time of testing. ( Hypovitaminosis D in British adults at age 45 y: nationwide cohort study of dietary and lifestyle predictors )
Note the variation during the year, with average results of: Winter 35 nmol/L (17.5 ng/mL) Summer 75 nmol/L ( 30 ng/ml)
Note the slight difference between men and women, which changes between the winter and summer.
England extends from 50-55ºN of the equator.
Dr David Grimes and Dr Oliver Gillie have both written about how the weather, & especially the sunshine of the UK, may affect the health outcomes of people from different areas. For example, the people of sunny Bournemouth in the south have better health overall than the people of Blackburn or Manchester, where it is more cloudy and rains more often.
24 UK Data – Scotland ( 56-57°N )
This chart was captured the day before the Vitamin D Update from a talk given by Professor William Fraser, Professor of Musculoskeletal Biology at University of Liverpool, UK. It is not known how many people were tested.
Note the variation during the year, with results of: Winter 8 nmol/L ( 3.2 ng/mL) Summer 44 nmol/L ( 17.6 ng/ml)
Scotland extends from 56-57ºN of the equator.
Dr Oliver Gillie has written 4 books about how the health of people in the United Kingdom suffers from lack of adequate sunlight.
One of them is about Scotland: “Scotland's health deficit: an explanation and a plan” and can be downloaded from: www.healthresearchforum.org.uk
25 Professor Robert Heaney Creighton University, Omaha NE
He has held faculty appointments at the University of Oklahoma, at George Washington University, and at Creighton, where for nine years he served as Chairman of the Department of Internal Medicine from 1961-1969. Dr. Heaney was Creighton’s first Vice-President for Health Sciences, a position he held from 1971-1984, and since 1984 has held the all-university chair named in honor of the University’s founder. Dr. Heaney serves or has served on the editorial boards of all the major scientific publications in the field of bone biology and chaired the Scientific Advisory Panel on Osteoporosis of the Office of Technology Assessment (U.S. Congress). He is a past member of the Board of Directors of Loyola University of Chicago and of the Association of Academic Health Centers, and currently is an emeritus member of the Board of Trustees of the National Osteoporosis Foundation. He served as a member of the panel on Calcium and Related Nutrients of the Food and Nutrition Board (NAS) in the most recent setting of the DRIs for bone-related nutrients. Dr. Heaney has worked for over 50 years in the study of osteoporosis, vitamin D, and calcium physiology. He is the author of three books and has published over 400 original papers, chapters, monographs, and reviews in scientific and educational fields. The major theme of his work has been quantitative physiology, for example, the elucidation of how much vitamin D was necessary to produce the nutrient’s canonical effect on calcium absorption, how much vitamin D is metabolized each day, how much vitamin D is synthesized in the skin, and the degree to which skin pigmentation modifies that synthesis, how much vitamin D is stored, and the extent to which input levels modify that change. At the same time, he has engaged nutritional policy issues and has helped redefine the context for estimating nutrient requirements. Specifically he has shown that nutrient deficiencies produce long-latency disease as well as their classical acute disorders, and has focused attention on the inadequacy of drug-based research designs for the evaluation of nutrient efficacy. [email protected] 26
A presentation was then given by Professor Robert Heaney: “Vitamin D – Evaluating the Evidence”
Following this he gave his comments about the IoM report
After this, about 20 of the audience gave comments and examples of their experience in diagnosing, testing and treating illnesses due to lack of Vitamin D
There was significant comment about the lack of suitable Vitamin D3 products available for UK doctors to prescribe, plus the significant variation in the pricing of Dekristol 20,000 IU capsules imported from Germany as “specials”
These documents are available on request from Rufus Greenbaum: ( Email: [email protected] ) • 2-page Overview & Summary • 28-page Report of comments and inputs from people at the meeting • List of attendees with copies of Business cards or contact information • Presentation – Introduction to Vitamin D in the UK ( By Rufus Greenbaum ) • Presentation & Notes – Introduction to Vitamin D in the UK ( By Rufus Greenbaum ) • Presentation – State of the Evidence ( By Professor Robert Heaney )
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